The Mount Sinai Injury Control and Research Center (MS-ICRC) will continue, in the proposed funding period, to focus on ameliorating the secondary and tertiary conditions that occur after traumatic brain injury (TBI), to address two goals: (1) improving quality of life after TBI and (2) extending the life span of people injured after age 40. We have added an additional emphasis: reducing violence and criminal behavior in youth who are at high risk. The proposed Research Program of the MS-ICRC includes: (1) An investigation of the impact of a behavioral intervention on violence and recidivism amongst youth (with TBI and without) who are on parole. This study translates an intervention we developed for an adult TBI population for use with adolescents at-risk for violence, and it comprises the first stud of an intervention for young offenders with TBI. (2) A pilot prospective cohort study of individual who sustained a TBI after age 40, to document health issues and other factors that may contribute to the accelerated aging and pre-mature death that has been documented in TBI survivors. (3) An analysis of a database developed by the Texas juvenile justice system to explore the relationship between TBI (and other health factors) and youth criminality, with a particular focus on violent offenses. This policy research follows extensive outreach by the MS-ICRC to the juvenile justice system in Texas that resulted in their decision to screen their population for TBI (using the MS-ICRC's Brain Injury Screening Questionnaire [BISQ]). (4) The establishment of a longitudinal database of all college athletes at St. John's University in New York City, to document at time of college admission lifetime history of concussion and to then prospectively document concussions sustained during college both on and off the field. Student-athletes will be followed to define the long-term consequences of concussions. This project will be fully manualized for replication in other institutions, to move toward the establishment of a national registry of college sports concussions. (5) A program of exploratory projects, to encourage other researchers to expand their work to address the MS- ICRC's long-term goals. Together, Projects 1 and 3 have strong policy implications for developing system-wide interventions to identify children with TBI at the earliest point possible and for providing subsequent accommodations, i.e., systemic interventions to reduce violence and criminality in young offenders, or school- based interventions to prevent children with TBI from taking the path that often leads from untreated long-term challenges consequent to injury to criminal behavior, homelessness and other forms of social failure. The proposed Outreach Program addresses MS-ICRC goals by building on the output of our current activities (2007-2012) and by weaving the results of proposed activities into outreach, as new products are developed and new implications for action emerge. Specifically, three interventions (cognitive behavioral therapy adapted to treat depression post TBI, and the Executive Plus and STEP treatment programs for post-TBI executive dysfunction) have been developed, evaluated and manualized. Planned outreach will focus on broad dissemination and support for adoption of these valuable additions to the TBI treatment arsenal. A second current focus is on screening for hidden TBI, through further validation of the BISQ and its adaptation for web-based administration. Outreach in the next five years will stress wider dissemination of the BISQ to screen additional populations, with the goal of effecting changes in policy in schools and in other settings where screening is needed to identify individuals with brain-injury related challenges, so that accommodations can be provided to prevent failure associated with unrecognized injury. Another emphasis is being placed on working with marketing experts to better tailor MS-ICRC outreach to meet the needs of our several constituencies. A new element of MS-ICRC outreach will be a Policy Think Tank, to review evidence based on MS-ICRC research and from the established knowledge base, and then to detail means and strategies to achieve policy change; the first area will be establishing systematic screening for hidden TBI. The Training and Education Program will continue to focus on supplying the field with qualified professional injury prevention practitioners and researchers, in the spirit of the training program established in 2007. Formal training will include a 2-year post-doctoral fellowship program and a 1-year pre-doctoral externship. In addition, we will educate service providers through webinars and workshops, symposia and lectures at professional conferences and institutions; we also provide numerous resources for professionals downloadable (gratis) on our website. Recommendations for curricula changes to be incorporated into programs for medical and other professional training will also be developed.